本文關(guān)鍵詞：胎兒泌尿生殖系統(tǒng)畸形產(chǎn)前超聲及磁共振成像診斷分析，，由筆耕文化傳播整理發(fā)布。

胎兒泌尿生殖系統(tǒng)畸形產(chǎn)前超聲及磁共振成像診斷分析

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摘要

目的探討產(chǎn)前超聲及磁共振成像(MRI)診斷胎兒泌尿生殖系統(tǒng)畸形的應(yīng)用指征和臨床作用。方法對(duì)產(chǎn)前超聲診斷為泌尿生殖系統(tǒng)畸形的227例胎兒均于24 h內(nèi)行MRI檢查,與產(chǎn)后檢查和臨床隨訪結(jié)果對(duì)照,對(duì)產(chǎn)前超聲漏誤診病例的圖像特征進(jìn)行分析。結(jié)果產(chǎn)前超聲檢出泌尿生殖系統(tǒng)畸形的227例胎兒中包括腎臟囊性病變70例、梗阻性尿路疾病41例、腎缺如40例、腎位置異常24例、融合腎18例、重復(fù)腎17例、腎腫瘤8例、雙腎體積小3例、膀胱病變5例、陰莖短小1例。與產(chǎn)后檢查及臨床隨訪結(jié)果對(duì)照,產(chǎn)前超聲正確診斷胎兒泌尿生殖系統(tǒng)畸形194例(85.5%,194/227);漏誤診33例(14.5%,33/227),其中15例(1例輸尿管息肉)梗阻性尿路疾病不能顯示輸尿管狹窄或梗阻部位、3例梗阻性尿路疾病不能明確診斷(1例巨輸尿管、2例腎積水)、3例梗阻性尿路疾病誤診為重復(fù)腎;其余12例漏誤診病例包括3例腎位置異常、2例重復(fù)腎合并囊性腎發(fā)育不良、2例腎缺如、2例融合腎、1例多囊腎合并重度積水、1例重復(fù)腎、1例陰莖短小。產(chǎn)前MRI正確診斷224例(98.7%,224/227);漏診3例(1.3%,3/227)。另外,3例泌尿系統(tǒng)異常伴發(fā)的生殖器異常,產(chǎn)前超聲、MRI均未顯示,均為產(chǎn)后發(fā)現(xiàn)。結(jié)論產(chǎn)前超聲及MRI對(duì)胎兒泌尿系統(tǒng)畸形有較高顯示率;但超聲及MRI對(duì)胎兒生殖器畸形的顯示率均不高。明確MRI應(yīng)用指征有助于產(chǎn)前合理選用影像學(xué)檢查方法,對(duì)診斷和佐證胎兒泌尿生殖系統(tǒng)畸形有重要臨床作用。
Objective To explore the indications of prenatal ultrasound and magnetic resonance imaging(MRI) in diagnosing fetal genitourinary abnormalities. Methods Two hundred and twenty-seven fetuses with genitourinary abnormalities detected by prenatal ultrasound received MRI examination within 24 hours after ultrasound. The final diagnosis was confirmed by autopsy or clinical follow-up. The results of prenatal ultrasound and MRI were analyzed retrospectively and compared with follow-up results. And the misdiagnosis of prenatal ultrasound in fetal genitourinary abnormalities were also analyzed. Results In 227 fetuses with genitourinary abnormalities, there were 70 fetuses with renal cystic lesions, 41 with urinary obstruction, 40 with renal agenesis, 24 with ectopic kidney, 18 with horseshoe kidney, 17 with renal duplication, 8 with kidney neoplasm, 3 with small kidney, 5 with bladder anomaly, and 1 with small penis. The diagnostic accuracy rates of ultrasound and MRI were 85.5%(194/227) and 98.7%(224/227) respectively. There were 33 cases of fetal genitourinary abnormalities misdiagnosed by prenatal ultrasound as follows: failed to detect the location of ureteral stricture or obstruction in 15 cases of urinary obstruction(including 1 ureteral polyp); failed to diagnose definitely in 3 cases of urinary obstruction(including 1 megaureter and 2 cases of hydronephrosis); 3 cases of urinary obstruction misdiagnosed as renal duplication; and the rest 12 misdiagnosed cases including 3 ectopic kidney, 2 renal duplication associated with cystic renal dysplasia, 2 renal agenesis, 2 horseshoe kidney, 1 polycystic kidney associated with severe hydronephrosis, 1 renal duplication and 1 small penis. There were 3 cases of fetal genitourinary abnormalities misdiagnosed by prenatal MRI. Neither prenatal ultrasound nor MRI could show the genitalia anomaly detected by postnatal examine, in all 3 cases of urinary system abnormalities associated with genitalia anomaly. Conclusions In fetal urinary system abnormalities, prenatal ultrasound and MRI have high diagnostic accuracy rates. However, ultrasound and MRI are both difficult to show genitalia anomaly. The indications of MRI in detecting fetal genitourinary abnormalities need to be defined to guide a reasonable use of fetal MRI.

引文

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  本文關(guān)鍵詞：胎兒泌尿生殖系統(tǒng)畸形產(chǎn)前超聲及磁共振成像診斷分析，由筆耕文化傳播整理發(fā)布。